Mannitol infusion is commonly used in the treatment of intracranial hypertension following traumatic brain injury. It has long been known to have stability issues, specifically, mannitol recrystallises from solutions greater than 10% w/v in ambient conditions. This can happen at any time, whether on the pharmacy shelf or during a medical procedure. This study describes the stability limits of 20% w/v mannitol infusion (the most common strength used clinically) and proposes a number of safer, stable and tuneable hyperosmotic formulations of mannitol in combination with clinically acceptable osmotic agents (NaCl, sorbitol and glycerol).
Reference:Kavanagh, O., Hogan, F., Murphy, C., Croker, D. and Walker, G. (2020) Formulating a Stable Mannitol Infusion while Maintaining Hyperosmolarity. Pharmaceutics. 12(2), p.E187. doi: 10.3390/pharmaceutics12020187.